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DOI: 10.1055/s-0032-1311532
Closure of Perimembranous Ventricular Septal Defects with Intraoperative Device Technique: Another Safe Alternative to Surgical Repair
Publication History
12 October 2011
21 February 2012
Publication Date:
08 June 2012 (online)
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Abstract
Objectives This study aims at assessing the safety and feasibility of intraoperative device closure of the perimembranous ventricular septal defect (VSD).
Methods Total 89 patients in group I with intraoperative device closure and 58 in group II with surgical repair were enrolled in our hospital to participate in the study from January 2009 to December 2010. In group I, the approach involved a minimal inferior median incision that was performed after full evaluation of the perimembranous VSD by real-time transesophageal echocardiographic guidance, and the insertion of an asymmetric or a symmetric domestically made device was used to occlude the perimembranous VSD.
Results In group I, 83 patients were occluded successfully under this approach. The size of the occluder implanted ranged from 6 to 14 mm. Complete atrioventricular block occurred in one case and Mobitz type II atrioventricular block occurred in one case during the procedure. One patient presented complete atrioventricular block one week after the operation. Two patients converted to surgical repair because of severe intraoperative aortic valve regurgitation. One patient with significant residual shunt transformed to surgical treatment. In our comparative studies, patients in group II experienced significantly longer operative time, ICU stay, and hospital stay (p < 0.001). The cost of group I was less than that of group II (p < 0.001).
Conclusions Minimally invasive transthoracic device closure of the perimembranous VSD with an asymmetric or a symmetric domestically made device without cardiopulmonary bypass is safe and feasible. It should be considered an acceptable alternative to surgery in selected subgroups. However, it is necessary to evaluate the long-term results.
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References
- 1 Tynan M, Anderson RH. Ventricular septal defects. In: Anderson RH, Baker EJ, Maccartney FJ, Rigby ML, Shinebourne EA, Tynan M, editors. Paediatric Cardiology, 2nd ed. London: Churchill Livingstone; 2002: 983-1014
- 2 Mavroudis C, Baker CL, Idriss FS. Ventricular septal defect. In: Mavroudis C, Baker CL. eds. Pediatric Cardiac Surgery. 3rd ed. Philadelphia, Pennsylvania: Mosby; 2003: 298-320
- 3 Kirklin WJ, Barrat-Boys BG. Ventricular septal defect. In: Kirklin WJ, Barrat-Boys BG, eds. Cardiac Surgery. 2nd ed. New York: Churchill Livingston; 1993: 749-824
- 4 Bol-Raap G, Weerheim J, Kappetein AP, Witsenburg M, Bogers AJ. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg 2003; 24 (4) 511-515
- 5 Carminati M, Butera G, Chessa M, Drago M, Negura D, Piazza L. Transcatheter closure of congenital ventricular septal defect with Amplatzer septal occluders. Am J Cardiol 2005; 96 (12A) 52L-58L
- 6 Fu YC, Bass J, Amin Z , et al. Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: results of the U.S. phase I trial. J Am Coll Cardiol 2006; 47 (2) 319-325
- 7 Kenny D, Morgan G, Bajwa A , et al. Evolution of transcatheter closure of perimembranous ventricular septal defects in a single centre. Catheter Cardiovasc Interv 2009; 73 (4) 568-575
- 8 Chen Q, Chen L-W, Wang QM, Cao H, Zhang GC, Chen DZ. Intraoperative device closure of doubly committed subarterial ventricular septal defects: initial experience. Ann Thorac Surg 2010; 90 (3) 869-873
- 9 Chessa M, Butera G, Negura D , et al. Transcatheter closure of congenital ventricular septal defects in adult: mid-term results and complications. Int J Cardiol 2009; 133 (1) 70-73
- 10 Quansheng X, Silin P, Zhongyun Z , et al. Minimally invasive perventricular device closure of an isolated perimembranous ventricular septal defect with a newly designed delivery system: preliminary experience. J Thorac Cardiovasc Surg 2009; 137 (3) 556-559
- 11 Xing Q, Pan S, An Q , et al. Minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: multicenter experience and mid-term follow-up. J Thorac Cardiovasc Surg 2010; 139 (6) 1409-1415
- 12 Hijazi ZM, Hakim F, Haweleh AA , et al. Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: initial clinical experience. Catheter Cardiovasc Interv 2002; 56 (4) 508-515
- 13 Bass JL, Kalra GS, Arora R , et al. Initial human experience with the Amplatzer perimembranous ventricular septal occluder device. Catheter Cardiovasc Interv 2003; 58 (2) 238-245
- 14 Thanopoulos BD, Tsaousis GS, Karanasios E, Eleftherakis NG, Paphitis C. Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer asymmetric ventricular septal defect occluder: preliminary experience in children. Heart 2003; 89 (8) 918-922
- 15 Arora R, Trehan V, Kumar A, Kalra GS, Nigam M. Transcatheter closure of congenital ventricular septal defects: experience with various devices. J Interv Cardiol 2003; 16 (1) 83-91
- 16 Gersony WM. Natural history and decision-making in patients with ventricular septal defect. Pediatr Cardiol 2001; 14: 125-132
- 17 Zheng Q, Zhao Z, Zuo J , et al. A comparative study: early results and complications of percutaneous and surgical closure of ventricular septal defect. Cardiology 2009; 114 (4) 238-243
- 18 Walsh MA, Bialkowski J, Szkutnik M, Pawelec-Wojtalik M, Bobkowski W, Walsh KP. Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects. Heart 2006; 92 (9) 1295-1297
- 19 Butera G, Massimo C, Mario C. Late complete atriovenous block after percutaneous closure of a perimembranous ventricular septal defect. Catheter Cardiovasc Interv 2006; 67 (6) 938-941
- 20 Yip WC, Zimmerman F, Hijazi ZM. Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheter Cardiovasc Interv 2005; 66 (3) 436-441
- 21 Zhou T, Shen XQ, Zhou SH , et al. Atrioventricular block: a serious complication in and after transcatheter closure of perimembranous ventricular septal defects. Clin Cardiol 2008; 31 (8) 368-371